COVID-19 route map for dental treatment

The Scottish Government has, as of 1st November 2020, permitted a full return of NHS dental services following the COVID-restrictions earlier in the year. This includes children’s dentristry, which is offered on the NHS at the Gentle Touch.

As the Gentle Touch is a private plan practice, we were able to return to nearly-normal treatments for adults much sooner than the NHS practices which were bound by the Scottish Government’s plan (“Scotland’s route map through and out of the crisis”). We had our own route map for how we achieved the full return of our service.

As the chief dental officer for Scotland said regarding NHS dental care, “we need to be mindful of the oral health needs of patients balanced against the wider situation with Covid-19.” The Gentle Touch will continue to follow all dental guidelines and exercise extreme (evidence-based) care.

Gentle Touch Route Map: Staged Approach

Our own route map started with lockdown, then moved from Stage 1 which allowed urgent dental care only to Stage 2 which includes some non-urgent treatments, including check-ups. We started to offer additional treatments under Stage 3 and by October 2020 we were also able to provide some preventive treatments for children under Stage 4 and now we can offer all NHS services for children.

Our Route Map works through 5 stages in total, which will gradually allow a full return to normal service.

We have implemented new procedures for when you attend your appointments, including changes to arrival and departure routines. These procedures will ensure a safe environment for you and give you peace of mind about attending your appointment.

Stage 1: prioritise urgent cases

For those patients with urgent dental care needs through lockdown, we were able to start to offer care in Stage 1.

We provided the following care to non-COVID-symptomatic patients – all strictly by appointment only:

• Urgent, then essential care to all private plan patients who had tooth or gum problems during the lockdown period (not including procedures that produce a water spray).
• Daily emergency appointments (not including procedures that produce a water spray).
• Patient purchases from the practice (if not self-isolating) of the following items: special toothpaste, mouthwashes, cleaning aids, etc.
• Home deliveries of these items (including antibiotics and temporary filling packs) will continue if patients are shielding (following remote consultation, of course).
• Referral of patients to our local urgent care centre in Coldstream (for severe toothache in a tooth that needs ‘water-spray’ treatment, for example, root canal treatment).
• Referral of all ‘NHS’ children (with toothache) to local urgent care centre.
• Remote new patient consults with our Patient Care Coordinator. Caroline can either get you signed up straight away to allow access to our emergency care or if in no hurry, you’re welcome to join our ‘wait-list.’

Stage 2: non-urgent care

We were delighted to open our services for non-urgent care from the 13th of July to non-COVID symptomatic patients. Our services remain strictly by appointment only. Care includes:

• Check-ups
• All the care we could offer during stage 1 of our Routemap.

The protection of patients and staff remains of paramount importance as we move forward. We appreciate your patience as we use our clinical judgment about how and when we begin to increase the range of procedures we provide. This is of vital importance so that we do not have an adverse impact on the National effort to keep COVID-19 under control. We will, therefore, keep you updated we move through the next stages!

Stage 3: treatments that involve a water-spray

Whilst wearing our next level PPE and observing extra stringent safety measures, we have been carrying out aerosol ‘water-spray’ treatments since the end of July. This includes the following care:

• Preventive sealants
• Silver and white fillings
• Root canal treatments
• Essential onlay, crown and bridge work
• Ultrasonic hygiene treatments (where indicated)

After every aerosol treatment (even if this lasts for five minutes), we must vacate the surgery for 60 minutes (fallow time), after which a deep clean is carried out. As such, we cannot (usually) carry out an unplanned aerosol treatment. This means that if we recommend a filling, we will be in touch to arrange an appointment as soon as possible (as we need to carefully plan the timings of treatment, fallow time and the deep clean). We are, however, working additional hours and weekends to be able to provide this service.

Stage 4: children’s dentistry

In October, we recommenced “preventive care” for children under the NHS. As of Monday 2nd November, we now able to offer a full range of treatments for children.

The complete move into Stage 4 has been possible since the Minister for Public Health, Sport and Wellbeing confirmed in Parliament that NHS dental contractors can now provide a full range of services to all NHS patients. In our practice this applies to children under the age of 18.

The way we carry out this care is still more restrictive than private dentistry, so we will plan how we are going to deliver this service. We will try to be as flexible as possible and will aim for this to be out of school hours or holidays. As always, we will triage this care and appoint those in most need first. Please call us if your child has a tooth ache or dental problem.

In order to be as safe as possible, we would appreciate if all children over the age of five, could wear their face masks (unless they are in the dental chair).

We are also able to make custom-made mouthguards, so please call to arrange an appointment.

Stage 5: normal service resumes

This stage will see a return to our full range of treatments, without lots of extra planning and “next level PPE”. We do not yet have a timeline for when this will be. Clearly, it depends very much upon the progress of the virus in Scotland in the coming months.

Stage 5 will mean we no longer have to allow a fallow period after surgery use, and COVID-related deep cleaning would not be needed between patients. As an example, this Stage will enable a filling to be done “there and then” – we’ll no longer have to schedule for a return appointment.